摘要
目的探究接受免疫检查点抑制剂治疗的晚期非小细胞肺癌患者发生超进展(HPD)的危险因素及生存预后,为临床早期识别HPD高危人群提供参考。方法选择2019年1月至2021年6月在郑州大学第一附属医院接受免疫治疗的316例晚期非小细胞肺癌患者,回顾性收集患者的一般资料、影像及实验室检查、治疗方案及预后信息等,将患者分为HPD组及非HPD组,运用单因素及多因素logistic回归方法分析HPD发生的危险因素,并构建列线图评分系统预测HPD的发生。结果316例接受免疫治疗的非小细胞肺癌患者中发生HPD的有13例(4.11%);HPD组患者的预后比非HPD组患者更差(P<0.05);转移位置数目≥3个、乳酸脱氢酶(LDH)变化量、糖类抗原125(CA125)百分比变化是非小细胞肺癌患者发生HPD的独立危险因素。受试者工作特征(ROC)曲线下面积为0.95,说明该模型预测能力良好。结论HPD是晚期非小细胞肺癌患者免疫治疗中的新型进展模式,与不良预后结局相关,转移位置数目≥3个、LDH变化量、CA125百分比变化对早期识别HPD高危患者具有提示作用。
Objective To explore the risk factors and survival prognosis of hyperprogressive disease(HPD)in patients with advanced non-small cell lung cancer receiving immune checkpoint inhibitor therapy,and to provide reference for early clinical identification of high-risk groups of HPD.Methods A total of 316 patients with advanced non-small cell lung cancer who received immunotherapy in the First Affiliated Hospital of Zhengzhou University from June 2019 to June 2021 were selected.The general data,imaging and laboratory examinations,treatment plans and prognosis information of the patients were retrospectively collected,and the patients were divided into HPD group and the non-HPD group,the risk factors of HPD were analyzed by univariate and multivariate logistic regression methods,and a nomogram scoring system was constructed to predict the occurrence of HPD.Results Among the 316 non-small cell lung cancer patients who received immunotherapy,13 patients(4.11%)developed HPD.The prognosis of HPD patients was worse than that of non-HPD patients(P<0.05).The number of metastatic sites≥3,the amount of lactate dehydrogenase(LDH)change and the percentage change of carbohydrate antigen 125(CA125)were independent risk factors for HPD in non-small cell lung cancer patients.The area under receiver operating characteristic(ROC)curve was 0.95,which indicated that the predictive ability of the model was good.Conclusion HPD is a new progression pattern in immunotherapy in patients with advanced non-small cell lung cancer,which is associated with poor prognosis.The number of metastatic sites≥3,the change of LDH and the percentage change of CA125 can prompt early identification of high-risk patients with HPD.
作者
张梦
高佳男
张国俊
常静侠
ZHANG Meng;GAO Jianan;ZHANG Guojun;CHANG Jingxia(Department of Respiratory and Critical Care Medicine,the First Affiliated Hosptial of Zhengzhou University,Zhengzhou 450052,China)
出处
《河南医学研究》
CAS
2023年第7期1153-1158,共6页
Henan Medical Research
基金
河南省自然科学基金项目(182300410378)。
关键词
非小细胞肺癌
免疫治疗
超进展
预后
列线图
non-small cell lung cancer
immunotherapy
hyperprogressive disease
prognosis
nomogram
